President Obama’s Department of Health and Human Services implemented a rule change to the Affordable Care Act (a.k.a. Obamacare) last week mandating that all health providers receiving taxpayer dollars must perform sex-change operations or lose their federal funding.

The final rule states that, under Title IX, any hospital receiving funding from HHS must “treat individuals consistent with their gender identity.” The rule provides no religious exemption. In other words, religious hospitals that receive taxpayer dollars via Medicaid or Medicare will be required to perform sex-change operations or get cut off financially.

The rule change is not the only directive from the Obama administration forcing individuals to embrace the transgender agenda. Just last week, the administration sent letters to every school district in the country mandating that they open bathrooms, locker rooms, and showers to all students, regardless of their biological sex. Meaning that under Obama’s directive, male students must be allowed to shower with female students if the former call themselves a girl.

HHS is currently embroiled in a legal fight with The Little Sisters of the Poor, a Catholic organization that provides housing and care for the elderly poor. In accordance with their religious beliefs, they do not provide contraceptives to their female employees, which the Obama administration says violates the contraceptive mandate in Obamacare. On Monday, the Supreme Court sent the case back down to the lower court to work out a compromise tweaking the mandate to address religious concerns.

Bre Payton is a staff writer at The Federalist. Follow her on Twitter.